Patient's Query
Hello doctor,
I wanted to reach out because the tremor in my left hand has gotten noticeably worse this month. Earlier, it only showed up when my hand was at rest, but now I notice it even when I am holding my phone or trying to put on makeup. It is becoming embarrassing at work because I keep dropping pens.
I am also feeling more stiffness in my shoulders and hips, especially in the mornings. I used to get up and start making breakfast for my kids right away, but now I need a few minutes just to stretch and get my muscles moving.
My doctor increased my Levodopa and Carbidopa dose two months ago, and while it helped at first, the “on” periods feel shorter now. By early afternoon, I can tell the medication is wearing off. Do we need to adjust the timing, or should we consider adding another medicine like a Dopamine agonist?
My mother also had Parkinson’s, and although I try not to compare myself to her experience, it is hard not to worry. I just want to stay independent for as long as possible.
One more thing, I have had a few episodes of lightheadedness when I stand up. My blood pressure last night was 98/62 mmHg. Could this be from the medications?
Please let me know if you recommend any labs, dosing changes, or additional treatments.
Thank you.
Hi,
Welcome to icliniq.com.
I read your query and can understand your concern.
What you are feeling is very common in Parkinson’s (a brain disorder that causes slow movement and tremors), especially the part where the medication does not seem to “last” as long as it used to. Let me explain it in simple terms, so you know exactly what is happening.
Your tremor is getting worse even when you are using your hand, which means your Levodopa (your main Parkinson’s medicine) is not staying effective long enough between doses.
When the medicine wears off, the brain has less Dopamine, the chemical that helps muscles move smoothly. That is why the stiffness and slow movements come back earlier in the day.
This pattern is called motor fluctuations, which simply means that you feel better when the medicine is working, known as “on” time, and your symptoms return when it starts to wear off, called “off” time. This is not your fault; it just shows that your body’s needs are changing over time.
What usually helps at this stage:
1. Adjusting your Levodopa schedule, which means sometimes taking smaller doses more often (for example, every four hours instead of every five to six), keeps the Dopamine level steadier.
2. There are two common add-on options your doctor may suggest. Dopamine agonists, such as Pramipexole or Ropinirole, work by mimicking dopamine in the brain, helping to reduce symptoms and make your movements smoother.
3. COMT or catechol-O-methyltransferase inhibitors, like Entacapone, help your Levodopa medicine stay active longer, which extends the periods when your symptoms are well-controlled, often called on periods. Both options are designed to complement your current treatment and improve daily functioning.
4. Using extended-release Levodopa, taking a slow-release version at night or first thing in the morning can help ease that stiffness you feel when you wake up, making it easier to start your day. We choose the right combination for you based on your daily routine and how your body handles side effects
About the lightheadedness (blood pressure 98/62 mmHg), feeling dizzy when you stand up is very common in Parkinson’s. The condition can affect the part of your nervous system that controls blood pressure. Levodopa and Dopamine-agonist medicines can sometimes make this worse.
You can try getting up slowly from bed or a chair. Drinking more water and slightly increasing salt (unless you have heart or kidney issues). Wearing compression stockings to improve circulation.
If this keeps happening, medications like Midodrine or Fludrocortisone can help raise your blood pressure safely.
Your mother’s Parkinson’s journey does not mean yours will follow the same path. Parkinson’s progresses very differently for every person. You are catching changes early, and that helps keep independence for as long as possible.
Share your exact Levodopa timings and when you feel the medicine start to “wear off.” Adjust the schedule or add a Dopamine agonist or a COMT (catechol-O-methyltransferase) inhibitor to stabilize symptoms. Get labs done like CBC (complete blood count), electrolytes, kidney function, vitamin B12, and vitamin D.
Low levels can worsen fatigue and stiffness. Check orthostatic blood pressure (lying, sitting, and standing) to understand your dizziness better. Based on these results, we can safely fine-tune your medications.
You are doing the right thing by speaking up early. These changes are manageable, and with the right adjustments, we can absolutely help you feel more stable, comfortable, and independent. I am here with you every step of the way.
I hope this helps.
Kindly revert so I can assist you further.
Thank you.
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Answered byDr. Prakashkumar P Bhatt
Medically reviewed byiCliniq medical review team
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